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General NPI Number Information
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NPI Number | 1649162819
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Entity Type | Organization
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Legal Business Name | MO SMILES LLC
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 19420 N 59TH AVE STE C253
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City | GLENDALE
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State | AZ
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Zip | 85308-6897
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Country | US
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Telephone | 623-934-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 8461 TURNPIKE DR STE 203
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City | WESTMINSTER
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State | CO
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Zip | 80031-4379
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Country | US
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Telephone | 720-627-7734
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Fax | 303-265-9247
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JUSTIN CANDELAS
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Credential |
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Telephone | 303-582-4157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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